Everybody Physical Therapy LLC
Health Insurance Portability & Accountability Act (HIPAA)- Notice of Privacy
Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU MAY OBTAIN ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.

Uses and Disclosures
Everybody Physical Therapy LLC will use your protected health information (PHI) for the purposes
of treatment, payment and health care operations.

Treatment includes the disclosure of health information to other providers who have referred you
for services or are involved in your care. This may include doctors, nurses, technicians and other
physical therapists. For example, we may feel that a stroke patient we are treating would benefit
from an evaluation by a speech-language pathologist to address a swallowing difficulty. The
health information we share with the speech-language pathologist would be considered a
treatment related disclosure.

Payment includes the disclosure of health information to your insurance company, including
Medicare and Medicaid, so payment can be obtained for services rendered. Your insurance
company may make a request to review your medical record to determine that your care was
necessary.

Health Care Operations includes the utilization of your records to monitor the quality of care
being given at out facility or for business planning activities.

Other Special Uses include use of your PHI to send you an appointment reminder, to inform you
of our other health-related products and services, and/or to send you a patient satisfaction survey.

Uses and Disclosures Required by Law
The federal health information privacy regulations either permit or require us to use or disclose
your PHI in the following ways: we may share some of your PHI with a family member or friend
involved in your care if you do not object, we may use your PHI in an emergency situation when
you may or may not be able to express yourself, and we may use or disclose you PHI for research
purposes if we are provided with very specific assurances that you privacy will be protected. We
may also disclose your PHI when we are required to do so by law, for example by court order or
subpoena. Disclosures to health oversight agencies are sometimes required by law to report
certain diseases or adverse drug reactions. We may use and disclose health information about
you to avert a serious threat to your health or safety or the health or safety of the public or others.
If you are in the Armed Forces, we may release health information about you when it is
determined to be necessary by the appropriate military command authorities. We may also
release information about you for workers’ compensation or other similar programs that provide
benefits for work-related injury or illness.

YOUR PRIVACY RIGHTS

Restrictions
Your have the right to request restrictions on how your PHI is used, however, we are not required
to agree with your request. If we do agree, we must abide by your request.

Confidential Communications
You have the right to request confidential communication from us at a location of your choosing.
This request must be in writing.

Access to PHI
You have the right to request a copy of your medical record. You must make this request in
writing and we may charge a fee to cover the costs of copying and mailing.

Amendments
You have the right to request an amendment be made to your PHI, if you disagree with what it
says about you. This request must be made in writing. If we disagree with you, we are not
required to make the change. You do have the right to submit a written statement about why you
disagree that will become part of your record. We may not amend parts of your medical record
that we did not create.

Accounting of Disclosures
After April 14, 2003, you have the right to request an accounting of the disclosures made in the
previous six years. These disclosures will not include those made for treatment, payment, or
health care operations or for which we have obtained authorization.

Complaints
If you feel that your privacy rights have been violated, you have the right to make a complaint to
us in writing without fear of retaliation. Your complaint should contain enough specific information
so that we may adequately investigate and respond to your concerns. If you are not satisfied with
our response, you may complain directly to the Secretary of Health and Human Services.

Our Duty to Protect Your Privacy
We are required to comply with the federal health information privacy regulations by maintain the
privacy of your PHI. These rules require us to provide you with this document, our Notice of
Privacy Practices. We reserve the right to update this notice if required by law. If we do update
this notice at any time in the future, you will receive a revised notice when you next seek
treatment from us.

Your authorization is required before your PHI may be used or disclosed by us for other purposes.
E-mail:info@everybodyphysicaltherapy.com